| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
204 |
195 |
$8K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
120 |
120 |
$5K |
| V2025 |
Deluxe frame |
82 |
82 |
$3K |
| V2020 |
Frames, purchases |
140 |
125 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
101 |
92 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
15 |
15 |
$312.50 |
| 92015 |
Determination of refractive state |
490 |
489 |
$0.00 |